Journal of the American Academy of Child & Adolescent Psychiatry
ARTICLESCombining Information From Multiple Sources in the Diagnosis of Autism Spectrum Disorders
Section snippets
Participants
Data were collected from 1,039 participants who completed a diagnostic evaluation at the University of Chicago Developmental Disorders Clinic (N =627; 497 males, 130 females), the University of Michigan Autism and Communication Disorders Center (N = 150; 115 males, 35 females), as part of a longitudinal study conducted through TEACCH Centers at the University of North Carolina, Chapel Hill (N = 129; 100 males, 29 females) and the University of Chicago (N = 80; 69 males, 11 females), or in a
Autism Diagnosis Case Criteria
Preliminary correlations between the diagnostic instruments showed the ADI-R total scores correlated 0.57 with ADOS total scores. Table 2 shows the results from applying five criteria using the ADI-R, the ADOS, or a combination of both for establishing an autism diagnosis, ordered from the most stringent (requiring autism diagnoses from both instruments) to the least stringent (requiring an autism diagnosis from either instrument).
Participants
The Canadian sample of 232 mainly white participants was ascertained as part of a genetic study of ASD. Families with more than one child with ASD were recruited; singleton participants were randomly selected for comparison purposes. As shown in Table 1, 79% of the participants had autism (79%), 8% had ASD (PDD-NOS or Asperger disorder), and 13% had nonspectrum diagnoses, most commonly language disorder or learning disability.
Procedure
The ADI-R and ADOS were administered in variable order to all
RESULTS: STUDY 2
Because only 19 cases in this sample had BE diagnoses of nonautism ASDs, analyses were conducted for autism criteria only. As in study 1, the combination of ADI-R and ADOS autism classifications yielded the most balanced sensitivity and specificity. As shown in Table 2, the positive predictive value of the stringent criteria was high, but because of the small number of nonautism participants, the negative predictive value was much lower than for the U.S. sample. Relaxing the ADOS (AUT) criteria
DISCUSSION
Autism spectrum diagnostic case criteria that use combined information from the ADI-R and ADOS better reflect consensus clinical judgments of autism and ASD than any single instrument. We do not know whether these results are specific to the ADI-R and ADOS or are specific to the areas covered by the different methods. The ADI-R provides a developmental history, a detailed description of the individual'S functioning in a variety of social contexts, and the opportunity to take into account
REFERENCES (22)
- et al.
Deficits in reciprocal social behavior in male twins: evidence for a genetically independent domain of psychopathology
J Am Acad Child Adolesc Psychiatry
(2003) - et al.
Reliability and accuracy of differentiating pervasive developmental disorder subtypes
J Am Acad Child Adolesc Psychiatry
(1998) - et al.
Genetic investigation of quantitative traits related to autism: use of multivariate polygenic models with ascertainment adjustment
Am J Hum Genet
(2005) - et al.
Quantifying dimensions in autism: a factor-analytic study
J Am Acad Child Adolesc Psychiatry
(2002) - et al.
Specifying PDD-NOS: a comparison of PDD-NOS, Asperger syndrome, and autism
J Am Acad Child Adolesc Psychiatry
(2004) Diagnostic and Statistical Manual of Mental Disorders
(2000)- et al.
Exploring the boundaries of Pervasive Developmental Disorder not otherwise specified: analyses of data from the DSM-IV autistic disorder field trial
J Autism Dev Disord
(1999) Statistics in Psychiatry
(2000)Differential Abilities Scale
(1990)Epidemiology of autistic disorder and other pervasive developmental disorders
J Clin Psychiatry
(2005)
Agenomewide screen for autism: strong evidence for linkage to chromosomes 2q, 7q, and 16p
Am J Hum Genet
Cited by (438)
Differential Diagnosis of Autism and Other Neurodevelopmental Disorders
2024, Pediatric Clinics of North AmericaAberrant Emotional Prosody Circuitry Predicts Social Communication Impairments in Children With Autism
2023, Biological Psychiatry: Cognitive Neuroscience and NeuroimagingAtypical cortical processing of bottom-up speech binding cues in children with autism spectrum disorders
2023, NeuroImage: ClinicalDDX3X Syndrome: Summary of Findings and Recommendations for Evaluation and Care
2023, Pediatric Neurology
This work was supported by grants NIMH R01 MH066496 and R01 MH46865 to Dr. Lord and was carried out as part of the NICHD/NIDCD Collaborative Programs for Excellence in Autism. The authors gratefully acknowledge the families who participated in these research projects and the staff at the TEACCH centers in North Carolina, the Department of Psychiatry at the University of Chicago, and the University of Michigan Autism and Communication Disorders Center.